Deaf since childhood, Josh Swiller always perceived the world a little bit differently than everyone else. And post-collegiate indecision hits a bit harder when you’re looking for a place beyond deafness. As a Peace Corps volunteer in Zambia, Swiller found a place where, if his deafness wasn’t irrelevant, it was at least not the most unusual thing about him. He worked at a health clinic, facing universal poverty and disease, and later, personally focused violence.. In his new memoir The Unheard, he proves it is not just his worldview that is unique, but his literary voice. The excerpt below is captivating peek at pediatric care, making due with the pills you’ve got, and when it’s time to turn off your hearing aids:

Mondays and Thursdays, I helped Jere with baby weighing to ensure that the growth of the infants of Mununga fell within healthy parameters. Weighing a single baby was fairly straightforward—you just placed it in a sling hanging from a produce scale. The problem was that each baby weighing there were more than three hundred babies and just the two of us to do the work along with Patrick, a young junior clinic worker who was inexperienced and high-strung. Crowds made Patrick jittery and he always excused himself within a half hour, claiming a fever or sore throat

“He’s sick a lot,” I said to Jere. Jere just shrugged.

Mothers descended on the clinic from every direction for the weighings, the line of them stretching out for a hundred yards. Some were dressed in their Sunday best and stood straight-shouldered, clean, and proud; others, dazed by hunger and covered in road dust, could barely stand. The youngest were thirteen and fourteen and held their infants like they were surprising things they had found by the road, and then the ones who looked too old to be mothers, who’d had a dozen kids and lost a dozen teeth and had breasts like piecrusts, were often only thirty-two, thirty-three.

The women placed their children, screaming hysterically at the sight of my white skin, in the green cloth sling and I wrote down the number the needle pointed to. If the number was low, mother and child were sent back to Jere who gave them a stern lecture, protein powder, and whatever vitamins he had in stock. If the number was really low, and it often was, then Jere sent someone to fetch me back to the office.

“Look at this,” Jere said during one of my first sessions, holding up two children, one in each hand, high in the air like glasses in a toast. “Two-year-old twins, two kilograms each.”

I looked: they had stick-figure limbs, the shrunken faces of very old men, bellies swollen like balloons. Jere laughed and held them out to me. “They weigh less than papaya. Here! Try for yourself.”
I didn’t move to take them. I couldn’t understand why he was laughing.

“Bamayo!” he yelled. He turned to the twins’ mother and gave her a tongue-lashing. She assumed an apologetic but defiant expression. But Jere kept on lecturing her until all the defiance left her face.

“Will they live?” I asked, after the mother had taken them away.

Jere scowled. “Not if they’re lucky. Why didn’t she come here earlier? Now they’re retarded. Their brains have been starved.”

Among the women at baby weighing, quite a few had given birth to a dozen children, and in these mothers, eyes gaunt from the experience, bodies hollowed out like gutted fish, there seemed sometimes to be an attitude that sick children were disposable. You sensed it in the way they presented a sick child for the scale—they’d already made their break. The flesh-and-bone infant in their hands, the fruit of their loins, might as well have been a turnip. We knew that at home, their other kids were getting the sick child’s share of food—and was that wrong? Someone needed to grow strong and work the fields; the mothers might as well hedge their bets.

Right or wrong that distance was a painful thing to see. Sometimes, in the middle of baby weighing, I tried to grab a little distance of my own. Stealthily reaching up, I turned off my hearing aids and continued working in silence. It was a coping strategy I had often used back in the States in noisy unintelligible places like dinner parties and restaurants; instantly, I was transported from the commotion to a hushed and peaceful place. However, turning my hearing aids off while weighing babies made everything more confused. What was peaceful about a five-pound child slung limply in my hands like an overstretched rubber band?

“I’m not doing enough,” I said to Jere, that night after the twins came to the clinic, thoughts of undug wells and malnourished children weighing on my conscience. “I feel like I need to do more.”

“How’s your chess these days?” he asked.

“Not very good.”

“I will teach you.”

I was bewildered. “That will help?”

“Oh yes,” said Jere. “I haven’t had a good game in seven years.”
—
Other days at the clinic, I often ended up in the office of Mr. Mulwanda, Mununga’s sleepy inpatient clinician. He counseled patients, handed out pills, cleaned infections, stitched wounds, and delivered babies. I liked that he let me help him do these things; he even taught me to clean and dress tropical sores on my own. But Mulwanda’s main prescription for the various illnesses and injuries he saw at the clinic was to tell people to go home and rest. The Mununga clinic, most likely the busiest rural health clinic in all of Zambia, had no blood supply, no IVs, no X-ray machine, no other diagnostic tools, and an inconsistent supply of the most basic drugs. The only thing the clinic never ran out of was aspirin. By necessity, Mulwanda had learned to tell people to take it easy.

The first time that I really gathered what Jere, Mulwanda, and Patrick were up against in their effort to treat illness in the town was when I had an injury of my own. While riding my motorcycle through a flash storm one evening, I hit a pothole and soared headfirst over the handlebars. When I went to the clinic to get my wounds cleaned up, Mulwanda pried a pebble out of my elbow, exposing a deep bloodless hole. We peered inside.

“What’s that gray thing?” I asked him.

“That is a vein,” he said.

“Should it be hanging out like that?”

Smiling, he batted it back and forth with his finger, like a cat playing with a string. He always smiled. “Sure, why not?”

Luckily, this was on a day when there were some medicines and Mulwanda prepared an injection of antibiotics to ward off the tropical bacteria that could turn a paper cut into flesh-eating soup in just a couple of days. Another patient, a young man, was led into the room just as Mulwanda was about to stick me, and he handed me the needle.

“Do this yourself,” he said, and went to the patient.

His calmness was comforting. I cradled the needle, flashing back to my father’s dream that I follow in his footsteps and become a doctor—Mununga College of Medicine, Class of ‘94—then I stuck it in my butt. Mulwanda called me over to his desk and put my fingers on the patient’s wrist.

“Feel this,” Mulwanda said.

“Feel what?” I only felt cool skin. Then suddenly something beneath the surface jumped and buzzed in all directions like an angry trapped bee.

I ripped my fingers away. “Jesus! What the hell is that?”

Mulwanda chuckled. “Irregular heartbeat.”

The young man looked up at me quickly and then back at the floor. He had put on nice clothes to come to the clinic, a spotless T-shirt and jeans ironed to a crease, and he looked too clean and healthy for such an erratic heartbeat. He had shoulders as broad as a market stall.

“How are you going to treat him?” I asked Mulwanda.

“A valium and an aspirin,” he said.

“That can’t be right. That can’t be enough. Give him something else. Give him some of these antibiotics.”

Mulwanda stood up from his desk. “Come look.” He took me by the hand to the clinic pharmacy, a small, windowless room no bigger than a hot tub. I’d never been inside before. There were three long shelves of drugs and vitamins, mostly aspirin, and a crate of condoms covered in dust—this was the total pharmaceutical supply for about fifty thousand people.

“You see?” he asked.

“That can’t be enough medicine.”

“It’s not.”

“What’s a Valium and an aspirin going to do for irregular heartbeat?”

Mulwanda’s eyes crinkled as he chuckled again. “He will sleep without a headache.”

“Ba Mulwanda, this is not a joking matter.”

“You are right,” he agreed. “Maybe you have some medicine?”

I didn’t have any medicine. A Valium and an aspirin would be all the young man would get. Mulwanda walked back over to him and told him to go home and rest.

Thing is, I started joining in the laughter about such things. Jere, Mulwanda and I—even high-strung Patrick at times—you had to find the humor, otherwise you just drove yourself nuts. You laughed about the babies who looked like space aliens, the kids who’d ignored their skin sores until they were the size of steaks, the men with cases of the clap so painful they walked like pigeons, the treatments made up out of the blue. Once a child who had not stopped hiccupping in two days was brought to the clinic, and I told Jere and Mulwanda that in America people frightened hiccups away. They had me run screaming into the room. The poor boy kept right on hiccupping while he pissed his shorts.

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